A traumatic hip dislocation occurs when the head of the thighbone (femur) is forcibly driven out of the hip socket (acetabulum). This injury typically results from high-energy trauma, such as a motor vehicle accident or a significant fall, and often involves accompanying injuries. Because the hip joint is naturally very stable, immense force is necessary to cause this displacement. A hip dislocation is a medical emergency requiring immediate intervention by trained professionals to limit potential long-term complications. This information is for educational purposes only, and any attempt by a layperson to reduce a hip dislocation is highly discouraged and dangerous.
Immediate Diagnosis and Pre-Reduction Protocols
Medical staff first rapidly assess the patient’s overall condition, checking for life-threatening injuries due to the severe mechanism of injury. Once stabilized, attention focuses on the injured hip, which is often visibly deformed. If a common posterior dislocation has occurred, the leg is typically rotated inward. A thorough neurovascular examination is immediately performed to check for compromise to the nerves or blood vessels, especially the sciatic nerve, which can be damaged by the dislocated femoral head.
Imaging is mandatory before reduction to confirm the diagnosis and identify associated fractures. Standard X-rays of the pelvis and hip determine the direction of the dislocation—most are posterior—and look for fractures of the femoral head or acetabulum. Urgent reduction is paramount because the risk of avascular necrosis (AVN) increases significantly the longer the hip remains dislocated. Consensus guidelines recommend reduction occur within six hours of injury to minimize this risk.
Since the procedure is extremely painful, procedural sedation and analgesia (PSA) are administered. This controlled process ensures the patient is comfortable and the strong hip muscles, which would otherwise spasm and resist movement, are relaxed. Muscle relaxation is essential for safe performance of the manual maneuver. An orthopedic surgeon should be consulted immediately and is often present during the closed reduction attempt.
Non-Surgical Methods for Hip Reduction
The goal of non-surgical, or “closed reduction,” is to guide the femoral head back into the acetabulum without an incision. This requires specific, controlled manual movements using leverage and traction to overcome muscle resistance. The procedure requires significant force and is typically performed with the patient deeply sedated and assistants stabilizing the pelvis.
One common approach is the Allis maneuver. The patient is placed on their back, and the knee is flexed to 90 degrees to relax the hamstring muscles. The physician applies longitudinal traction by pulling upward on the leg while flexing the hip toward 90 degrees. Traction is maintained, often combined with gentle internal and external rotation of the femur, to encourage the femoral head to slip back into the socket.
Another technique utilizing gravity is the Stimson maneuver. The patient is positioned face-down with the affected leg hanging over the edge of the bed, with the hip and knee flexed to 90 degrees. Gravity provides continuous, steady downward traction. The physician applies a downward force on the calf while gently rotating the leg internally and externally until reduction is achieved.
The reduction is often signaled by a distinct “clunk” sensation and sound as the femoral head pops back into place. Variations, such as the Captain Morgan or East Baltimore Lift, exist and are chosen based on the physician’s preference, the dislocation type, and the number of assistants available. Regardless of the method, these highly technical movements require precision to avoid causing further injury, such as fracturing the femoral neck.
When Open Reduction Surgery is Required
While closed reduction is the preferred initial treatment, certain conditions necessitate an immediate transition to “open reduction,” a surgical procedure. Open reduction is required when the hip is deemed “irreducible,” meaning manual maneuvers have failed. This failure often indicates that bone, cartilage, or soft tissue (such as the ligamentum teres or joint capsule) is physically blocking the joint space.
Surgery is also required in cases of fracture-dislocation, particularly those involving a large fracture of the posterior wall of the acetabulum or a significant femoral head fracture. If a large acetabular fragment is present, the joint may remain unstable even after closed reduction, necessitating surgery to fix the fracture and restore stability. The goal of open reduction is to surgically open the joint, remove entrapped fragments or debris, and accurately reposition the femoral head.
Following the reduction, the surgeon stabilizes any associated fractures using plates, screws, or other internal fixation devices. If the procedure is delayed, loose fragments within the joint space can lead to long-term joint damage and post-traumatic arthritis. Therefore, if initial closed reduction is unsuccessful or if imaging reveals a complex fracture-dislocation, the patient is moved urgently to the operating room to ensure a stable, anatomically correct joint is achieved.
Immediate Post-Reduction Care and Stabilization
Once the hip is successfully reduced, the immediate next step is confirming the correct joint position. Post-reduction X-rays verify that the femoral head is concentrically seated within the acetabulum and check for new fractures caused by the maneuver. A computed tomography (CT) scan is highly recommended, as it provides a detailed, three-dimensional view to identify subtle fractures, small bone fragments, or loose bodies not visible on standard X-rays.
Following confirmation of stable reduction, a repeat neurovascular assessment ensures the process did not cause new nerve or vessel damage and documents the resolution of pre-existing deficits. The patient is admitted for observation and pain management, which remains significant even after relocation. The injured leg is usually immobilized in slight abduction, often using a foam pillow between the knees, to prevent accidental redislocation.
Monitoring for complications is a primary concern in the immediate post-reduction period, especially the risk of avascular necrosis (AVN) of the femoral head. Initial care focuses on protecting the joint while the surrounding soft tissues begin to heal. Patients are generally kept on restricted or non-weight-bearing status for a period, allowing the joint capsule and ligaments to tighten without the stress of bearing body weight. This initial phase marks the beginning of the recovery process and eventual long-term rehabilitation.